Q&A on Senior Housing with Former HUD Secretary

Henry Cisneros discusses his new book on senior housing and what local and federal governments need to do to address the housing needs of seniors.

AP/Eric Gay

Explore the topic of aging in America through in-depth stories, data and interactive content at governing.com/generations.

Henry Cisneros -- the former San Antonio mayor, Housing and Urban Development secretary, and now real estate investor -- has now taken on another role: editor. 

This spring, University of Texas Press published his new book, Independent for Life: Homes and Neighborhoods for an Aging America. The book's 20 chapters are written by a variety of authors, including former Atlanta Mayor Shirley Franklin and Chattanooga, Tenn. Mayor Ron Littlefield.

It serves as a guide for policymakers and practitioners on how urban and building design will need to change in order to address the needs of aging baby boomers. Governing
's Ryan Holeywell asked Cisneros what the local and federal government can do to address the challenge. This interview has been edited and condensed for clarity.

Ryan Holeywell: How did this become such a big issue for you? Did it come on your radar while you were at HUD?

Henry Cisneros: It's been an issue on my mind for a long time, even before  HUD. I used to go to town hall meetings in communities and neighborhoods. I noticed in some neighborhoods, everyone was older. The housing stock was older. The problems they brought to the table were unique. They had different concerns about security. They had different concerns about access and isolation and municipal services of various kinds. I thought, if a city were to intelligently use Census data to identify which neighborhoods were growing older as a result of the fact that children had moved on and parents stayed ... we'd actually regard those neighborhoods as different. 

Years later, I was asked by AARP to speak on the community issues surrounding aging. From that, a number of people chimed in and said this is a subject that's really important. We should work on this. 
The rationale is the following: American is aging very rapidly. We have about 40 million over age 65 presently. In 2030, we'll have 72 million. They're growing in absolute numbers. They're growing as a percentage of the population. Luckily, the U.S., will have an infusion of young people as a result of immigration, which is not the case in Germany or Japan. We'll have a larger, older population, but we'll still have some balance. This is a good thing from a societal and economic standpoint. But it doesn't absolve us from having to pay attention to the sheer realty of larger numbers of people who will be frail, who will be dependent on different kinds of services, and who will need help. 
The book focuses on those people who've made the decision they'll stay at home. Only 5 percent of older people will be at a nursing home. The vast majority will be in their own homes. As as a country we not only have to think about increasing the stock of housing that's appropriate for their age, but also adapting the stock we've got, especially for those who will stay in their own homes. 
My mother is 88 and lives in a home that, my dad years ago added boys' rooms and storage space to in the attic. But you have to climb the stairs to get to it. That's off-limits to her. She can't handle those stairs, and certainly not when she's home alone. There's adapting restrooms, leveling showers, installing proper lighting for night use, communication systems that allow people to convey they're in trouble, transportation systems that link households so people can get to doctors' appointment and groceries. 
I'm finding that, as I go across the country, there's an awful lot of ferment and interest, especially in states that are aging the most.
RH: Do local officials understand this challenge yet, or is it just starting to bubble up?
HC: There's a handful of communities that get it. People like Mayor Ron Littlefield, who wrote a chapter in the book, and Davis, Calif. which, is allowing denser housing on the same lots so you can build multi-generational housing.
There are communities that are moving there. This so-called villages network. It started in Beacon Hill but spread. It's very smart. Communities are figuring it out. But many other mayors -- it's just coming to the floor, and people are saying "Oh my God, that makes sense! I get it!" I think you'll see over the next few years lots of focus. I think you'll see municipal workshops. You'll see people like the U.S. Conference of Mayors and the National League of Cities realizing this is an important issue. You'll see foundations and other public interest groups get into funding projects. We're just on the cusp of recognition.
RH: It sounds like there are two issues -- the urban planning side, and the housing side -- and on the planning side, it sounds very similar to New Urbanism and Smart Growth. Is there more to it?
HC: The four themes are: One, what do you do about existing homes? My take is we need to be talking about a strategy like retrofitting existing homes the way we talk about addressing energy efficiency in homes. That would be a huge breakthrough, to use existing federal programs like CDBG to help people retrofit their homes.
Second, it's existing communities, and what do we do about communities where everyone is older. How do we stitch together, virtually, a sense of community that has been lost so that people don't feel isolated? When we do town halls, the people tell us their number one fear they have is being left alone. It's finding ways to patch people together in a virtual community when you have a neighborhood in place. That's not urban planning. It's an intelligent extension of services.
Thirdly, it's the new home. We don't need McMansions. We need it to scale. We need to accessorize it for the elderly. 
The fourth piece is new communities. This is a lot like the New Urbanism. But you have to be intentionally conscious of the need to keep older folks in mind. I think the New Urbanism works for every age group. 
We organized the book around those four design issues. The fifth is the whole rubric of community services, and also technology and the appliances that can be adapted to break down the isolation to connect people and get services to them. 
RH: You've worked on both the government and the private-sector side of housing. Does the private sector have an incentive right now to do what's needed?
HC: The private sector will do a lot of this at the moderate to upper income levels. It's not rocket science. We know what the pieces are. They're affordable to people of the upper-middle to upper income. They're available. 
The trick is going to be recognizing that aging will impact every income demographic. We've got to engage government in figuring out how to make a lot of this available at middle-income and below. 
RH: Are the more unique housing options, like accessory dwelling units or co-housing, the solution? Or will they remain a niche?  
HC: I don't think they'll ever be the dominant form. But their percentage as a solution will grow. The absolute number will most certainly accelerate. A lot of what we described in this project is driven more by local governments than federal. It's a matter of recognizing the new constituency and the new population and tailoring government programs to meet those unique needs.

RH: Can this be addressed by expanding HUD's 202 affordable housing program for seniors?
HC: The 202 program is a separate thing. It's subsidized housing. This is about the mass of aging Americans. It's not about a few hundred thousand or a million people. It's about millions -- the millions in the middle who are neither candidates for subsidization nor wealthy enough to pay for the more resort-type communities. If we're smart about this, we can do this relatively inexpensively by working in the existing housing stock. It's not like we have to build new homes. We just need to make sure we have some ramps, we eliminate stairway entrances, bathrooms have walk-in showers, fixtures are lowered, you have latches and levers you can turn instead of things that are hard on the wrist, and so-on.
When we look at the medical analysis, it shows people who stay in their own home can feel greater independence, maintain their health, and do not have to be rushed by their families into the most expensive for of care there is, which is end-of-life care. They can stay in their homes for 10 or 15 years, provided we accessorize them properly. This country can save a lot of money on these buildings. 
Communications manager for the Texas Medical Center Health Policy Institute